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Access was pretty limited in Turkmenistan, and quite slow even in the capital of Ashgabat. So I didn't even try to blog from there.

Ashgabat was amazing, and I don't even know where to begin. The crazy dictator? The massive white marble buildings? The omnipresent statues, 30' x 40' banners, and sculptures of Turkmenbashi (the former president/dictator)? The lovely national dress the women wore? The massive state subsidies (70 liters of gas cost 1 US $. Water and electricity are free. Rent costs the equivalent of $2 a month. Intra-Turkmenistan flights cost $US 1.50)? The mountains that ring the city? The amazing friendliness and kindness of the Turkmen I met and worked with?

I think I took over 300 pictures. I'll have to find somewhere else to post them. I'll get working on that. And I'll also start posting in more detail about Turkmenistan while I'm in Almaty. I'm here for a few weeks, then off to Tadjikistan for the last two weeks of August.

Den' Rozhdeniya, part II

(Den' Rozhdeniya = Birthday)

My doorbell rang around 7:30, and there stood my friends with their son, also carrying a bouquet of flowers and gifts. I was told that the lovely pair of silver and blue flower earrings and matching necklace was from them, the flowers were from Steve, and the card (featuring a stout little dog with his tongue hanging out) was from Pookie! :) How sweet.

Then we went to a Chinese restaurant near the ginormous, Soviet-esque Almaty theatre, circus, and new Hyatt. I enjoyed my 0,6 liter bottle of Tsingtao and the food very much. No American-i-fied Chinese food here. We had cow stomach, among other more pedestrian choices like bean sprouts, spinach, Chinese seafood soup, and the like. The toasts were flowing, with them wishing me a long life, good health, much happiness, and our celebrating more birthdays together. After several hours of conversation, we realized it was nearly midnight and had a lovely long stroll back to my place.

On the walk back home, we passed one of the camels. No, not a real-life camel. As with the crabs of Baltimore and the cows of Chicago, Almaty has camels decorated by local artists and scattered throughout the city.

I went to bed tired and happy. It had truly been a lovely day full of surprises, kind words, and kind sentiments that helped take my mind off of being so very far away from home and those that I love on a special day.

This last shot is a view from the restaurant: the partially obscured white glowing dome with the green body and yellow tip on the left is the circus, and you can see the mountains in the background. Some newer buildings are also visible. Almaty is experiencing a huge construction boom, and the difference between these sleek, modern, glass-and-steel buildings and the hulking Soviet behemoths is jarring. I'll get some shots of some good Soviet architecture when I get back.

Saturday I am off to Ashgabat, Turkmenistan for 8 days. Don't know how much posting is going to happen from there, so I may be taking a brief hiatus from blogging if access isn't widely available. Look out for future posts about 110+ temps and what a crazy dictator can do to a nation...

Happy Birthday to Me

Today the earth revolved around the sun in such a way that I get to state I'm one year older than I was yesterday.

I expected a rather low-key day, since I wasn't about to run around advertising the fact that I'm steadily marching toward the big "four-o," but that was not in the cards.

This morning as I was stepping through the gate into the front yard of our building, I turned to see a colleague. I greeted her with a "Good morning," to which she replied "Happy Birthday!" That continued throughout the day. I guess I'm the only one that didn't get the memo.

Today during lunch (did I mention that we have a cook and eat a marvelous, three-course lunch daily?) they had a little toast and gave me a lovely bouquet of flowers, a small, handmade, leather yurt knick-knack, and an absolutely gorgeous pair of chandelier silver and turquoise earrings, Kazakh-style. I was (and still am!) overwhelmed at their generosity and kindness. I haven't been here very long at all, so wasn't expecting anything at all. Needless to say, I was bowled over with how quickly I've been accepted into the fold.

Tonight I'm going out to celebrate with my friends. They're going to pick the restaurant since I'm clueless in that regards, but I'll definitely take some pics and let you know tomorrow how birthdays are done Almaty-style.

On Language

Last night I spent 10 minutes laughing my ass off at the Russian pronunciation of "Huckleberry Finn" so I thought I'd devote this entry to the idiosyncracies of language.

Huckleberry Finn, or "GACK-lll-beRRRRRRy FEEEEEEN" as the Russians pronounce it, was one of the few American-ized words I struggled to understand. Generally, words from business and technology like "kompyooterrrr" and "biznizmen" are self-explanatory. The Russians tend to turn an "h" into a "g." To wit, Guckleberry rather than Huckleberry. Gepatit rather than hepatitis.

But then I said "Geminwaaaaaay" to Russify Hemingway, and they all looked at my blankly. So in English, I said "Hemingway. Ernest Hemingway." To which they all said "AAaaaaah. Heminwaaaaaay."

WTF? Now they suddenly can pronounce the H? This is not so normal.

Speaking of normal....

My other favorite Russian word: normal'no, or normal. It's used for everything. "How's the weather?" "Normal." "How was your trip?" "Normal." "What did you think of the movie? "It was normal." "What was the restaurant like?" "Well, normal." What, as opposed to abnormal?

Obviously, normal is more along the lines of OK, fine, decent. But it's so similar to the American "normal" that sometimes it's easier to interpret it as the American "normal" and think their response is funny. And when I say "not normal," everyone is like "Ooooooooohhhhh." It's a pretty strong statement to make.

And the other night a question about "maniacs" came up. No, not like "She's a maniac, maaaa-niac on the floor. And she's dancin' like she's never danced befooooooore." As in, "Are there a lot of maniacs in American like we see in the movies? Yannow, the kind that seem normal (there's the word again) but then go kill and maim women in run-down motels in the middle of nowhere?"

Hollywood has really made my work cut out for me here. I've got to explain things like Texas chili (We see JR Ewing on Dallas eating chili, what is that?), come up with statistics like what proportion of the American population is an axe-murderer, and what real prostitutes look like (yes, Pretty Woman. I explained to them what Baltimore City crack hos looked like, which was not too terribly much in line with Julia Roberts).

So amidst fighting my way through language idiosyncracies, I strive to more accurately report about Life In America. After all, we don't all live the lifestyle of JR Ewing and Richard Gere!

New and Improved! Now with Photos!

A shot of the Kazakh border from the Kyrgyz side, where it took us nearly 4 hours to work our way through. (Patience is a virtue!)


As you can see, I've finally trotted my booty to Cafe Dellia so I could upload some pics to this blog to break up the monotony of my posts. If you page down to previous posts, you'll see more photos I've added in. I hope you enjoy the scenery as much as I have.

I am sitting outside the cafe, watching (not a lot of) traffic go by, people walking by, and other cafe clients. Since it's got free wi-fi, there are always foreigners here. And of course, always present are the local elite that can afford a $3 cappucino and $5 Perrier.

Last night I visited my friends, Roman and Anara, bringing some Godiva chocolates, Jim Beam, and Pimm's I picked up in Heathrow at Duty-Free. I made them Pimm's Lemonade, which was yummy. Something very British. What else could I do during my 5.5 hours at Heathrow, other than learn to make new cocktails??? :)

They live across the hall from Roman's parents, who were watching their granddaughter (Roman's sister's little girl). Eventually Roman's sister (Alyona) and her husband (Vassily) came over so there were a lot of people asking me questions about America (what else?). Then they took me to Medeo, the world's highest-altitude skating rink built in the mountains near Almaty so I could look down upon Almaty at night. It was quite chilly up there, with crisp, clean air and Kazakh horses clip-clopping around. But absolutely lovely. We are definitely going to go back during the day. And I just may take myself out there for a hike one of these weekends, if time permits. This place is on the way to Chimbulak, their ski slope, which I cannot wait to hit this winter.

Then off to Alyona and Vasya's flat for some beers and conversation. They were shocked to hear about how expensive health care was in the states, and also how high our tax rates were. They also figured out pretty quickly I was a democrat, which wasn't too hard with all of the Bush-bashing that I was doing. At the end of the evening, based on questions I had answered for them. both women said that they would like to try living in America, whereas both men said they wouldn't mind a visit, but wouldn't want to live there for good. Interpret that as you wish.

Weather-wise, everyone is complaining about the heat but I am grateful for the temps only in the mid- to high-70s with zero humidity. I don't miss Bawlmer's 100+ heat index days in the least. Today is in fact cloudy and cool, and slightly drizzly. So I've moved under an awning and am tippy typing away in the cool summer air.

Across the street I spied a store my friends told me about, Interfood. It's a store that stocks exclusively foreign food. On the window in English it reads "weekly food deliveries by plane from Germany." It is supposed to be insanely expensive, but also a place where you can find uniquely American (and evidently German) goods. I think I'll pop in once I'm done here to see just what they have and see just how pricey it is. I'm happy buying fruits, veggies, and homemade bread and yogurt from the Green Bazaar, however. Yesterday I loaded up on stuff like bean sprouts, cilantro, green onion, peppers, tomato, etc. There are Korean women selling salads and spices, Turkish women selling cheese, yogurt and bread, Kazak women selling fermented mare's milk (mmmm!-NOT), Uzbek men selling dried fruit and nuts, Russian men and women selling clothing, shoes, and toiletries....truly a melange of ethnicities and goods. And 10 minutes into the shopping trip I started shoving people around and cutting in front of them just as much as they were shoving into/cutting in front of me. The Western notion of a personal space bubble has not caught on here yet. So when in Rome....shove back as the Romans do. ;>

Hooray for found baggage

My suitcase finally arrived!

They took one my carry-ons away from me in Heathrow--the one with all of my makeup, contact lenses, pictures, and other personal effects that I wanted to make sure made it with me. (Thank heaven I had the good sense to pull out meds, important paperwork, and lock the stupid thing.) That little rolly-bag never made it onto the plane, despite a long 5.5 hour transfer time at Heathrow. The following day a gas line explosion occurred nearby, resulting in a runway being shut down and half of the flights cancelled. With all of the enusing chaos, my poor personal effects were lost for nearly two weeks.

But today I can finally put on some makeup, contacts, sunglasses, and look like an Almaty girl (they have a very high maintance look). I can also put pictures of Steve up everywhere. :) (Hi, Steve! I miss you!) The driver is taking me to the airport at 2. I am a very happy girl, and around 3 pm I will be a much more glam girl. YEAH! Now I'll finally fit in around here! ;>

Chauvinism is not dead

So this morning I had the TV on as background noise while getting ready to go to work. "Good Morning" was on. It's a Russian morning television show, a la Today or Good Morning America. I should have known it was fluff and changed the channel when they had a segment on mail order brides, but I didn't.

So this piece comes on about feminism, and women who are feminists. They showed an attractive, well-dressed woman driving her own car, parking it, and meeting her man for lunch. In-between the serious discussion and interviews, this woman's story is told in a soap-opera-esque setting.

They cut from this dramatization and begin interviewing an "expert" (you'll see why I am using this term loosely in a moment). I do a double-take when I hear him say "Women who try to work as hard as men suffer negative effects to the immune system." I tilted my head at the "expert" questioningly, thinking that perhaps I misunderstood because it just can't be that he is saying something so inherently ridiculous.

But no, that is not the case. This "expert" continues to say that women may try to work as hard as men and achieve as much as men, but they will never do so and it will just be a stress to their physical and emotional health. At this point, the soap opera shows the feminist's man try to hold her hand over lunch, which she pulls away. Then she dramatically puts her hand to her head, pulls out some pills from her bag, and takes them. I guess feminism gives one headaches?

The "expert" then states (I shit you not) that working hard actually makes women's looks suffer: they become ugly when under stress of work and long hours. Soap-opera girl pulls out a mirror from her purse and appraises herself critically. Then when the waiter delivers the bill, she grabs it, pays for her half, and leaves the rest for her man.

To be fair, they did state that what's important is to find a balance between work and personal life at the very end (where soap opera girl was strolling with her man in a park, then as they sat on a bench not only allowed her man to hold her hand, but then placed her hand over his). But that's hardly enough to redeem themselves from the other insane things they said!

So ladies, if you want to be pretty and healthy, don't be a feminist. Let men do the hard work.

Lord have mercy.

Men here offer help with your things in the guise of being a gentleman, but I get the feeling that they think women are weak and incapable, and therefore need the help. Which is so ironic, given that women in Russia (and many other former Soviet countries) run the household. Under Communism, Russian feminist writers likened Russian society to urban black society in the US: A matriarchy. It's women that call the shots and run the show, which is to be expected when the alchoholism rate among men is so high.

It seems to me that not much as changed on the chauvinism front since the last time I was here. What a pity.

Bishkek, Kyrgyzstan

Ah, sweet, wired, Bishkek!

While it was nice to be in the boondocks at 2000+ meters altitude in the fresh, clean, air, I was happy to trade in the dirt path where I had to sidestep goat poop for Bishkek and its sidewalks, internet cafes, and AC. Country living feeds the soul, but in my case, only for a few days. Then the city girl in me comes out and I am happy to be using flush toilets and the Internet.

It was an absolutely breathtaking drive from Karakol to Bishkek. When I get back to Almaty I can finally upload all of my photos from my laptop. Tons of mountains, yurts where people sell dried fish and Kimiz (fermented mare's milk), a glorious view of the lake, and many, many cows, goats, and horsemen. I even saw a motorcade, some bigwig was likely heading to Issyk-Kul (the lake) for vacation. The graveyards here are spectacular--people build these enormous mosque-like buildings in memory of someone who died, and the custom is to leave it untouched so that it crumbles to the ground some day. Ashes to ashes and all that. Very neat.

I am finding the Kyrgyz an interesting, extremely hospitable, and very proud people. They, too, are of Turkish and Mongol extraction, as are many in Central Asia. Historically, however, they never fell under any of the empires that overtook many neighboring countries: Alexander of Macedonia, the Ottoman empire, and Ghenghis Khan all came to the borders of Kyrgyzstan but never invaded. Whether it was a function of geopolitics (the country is surrounded by mountains) or a lack of vast reserves of natural resources like neighboring Kazakhstan, they don't know. Under Czarist Russia, they willingly became a region/partner/something-or-other so that they could take part of Russia's power and wealth. Under the Soviet Empire, the country took many great steps forward in developing from a yurt-dwelling, agrarian society to one with a decent infrastructure, educational system, etc.

It was fascinating to listen to the Kyrgyz and Moldovan I was working with talk very matter-of-factly about the gains that were made in their countries as a direct result of communism. Both are ob/gyns, the Moldovan one of 10 children of Kolhozniks. He said that 8 of the 10 children have a higher education, and only because the communists provided it free of charge. There was very little animosity or bitterness, and they acknowledged that had it not been for the Soviets they wouldn't even speak a common language. Then they asked me what is taught in America about why the Soviet Empire crumbled, and we had a fascinating discussion about historical events and how everyone writes about the same event differently---particularly the victors and the losers.

I love getting very broad, general questions about how things are in America because I can always equivocate. :) Even stuff like what people like to eat varies from region to region, whether you're an immigrant or been here forever, urban, rural, etc. I think my colleagues got sick of me saying "it depends" every time they asked me a question about America. But it really does. I guess it takes going to a relatively homogeneous place (though there are Russians, Tadjiks, Chinese, Koreans, and other diaspora here) to realize just how much variety there is in the States.

Speaking of being from America, today a Kyrgyz teenager said something funny when I told him where I was from. Yesterday I had gone to his internet cafe and it was down. Today he said it was down and I was like "What's up with that?" (in Russian, of course). He started directing me to another place and asked if I knew where Gogol street was, to which I responded, "I've only been in Bishkek one day." So of course I get the requisite "where are you from" questions. Most adults have already met Americans, but I think I was the first for this kid. He said "So cooooool." and then inhaled deeply on his smoke. :) That cracked me up.

A note about technology. I bought a new SIM card for my cell phone and was able to make and recieve phone calls in the freaking BOONDOCKS of Kyrgyzstan. As I was lying there on the bed in my room, chatting with my mom (Hi, Mom!), I just couldn't get over what technology has done to our world. Here in a part of the world where a maternity hospital doesn't have hot running water, where the roads are filled with ruts and potholes so vast that most driving takes place at 5 MPH, weaving all over the road to avoid potholes, and where some people still live in yurts, I'm talking to someone 180 degrees around the world on a wireless connection. It blows the mind. Five years ago, I would have had to trudge 30 min to the center of Karakol, go to the main telephone office, order an international phone call, wait for the operator to repeatedly dial the number until she got a connection, then shout out a cabinet number where I would run and pick up the phone. Amazing.

Though I do miss ordering those phone calls. :) There was that thrill of anticipation that just doesn't exist when you can dial 'em right up, yannow?

For those CCP people reading this: my work hours are about as the Handbook. We worked all weekend, and after a brief tea break Sunday night, worked until 11 pm writing up how well (or not well) each maternity is doing with adopting and implementing Safe Motherhood technologies, and making recommendations for improvements. *sigh* I guess there's no rest for the wicked.... ;>

Karakol, Kyrgyzstan

I am enjoying life in Karakol, despite a painfully slow internet connection at the local internet cafe and a problem with water neccesitating my using an outhouse.

There's a conference in town, and so all of the hotels are booked. We are renting out a private home of a lovely Kyrgyz woman with a beautiful garden and an even more beautiful view of the mountains. In addition to be able to go up to fruit and berry trees and bushes and eat cherries and raspberries greedily straight from the trees/bushes, when she serves us tea it's with homemade breads, jams, and even honey. Heaven! Way better than hotel gruel, and I hear the main hotel is rather gnarly.

Today was another maternity hospital. This one was way nicer than the last, which isn't saying much. No heat other than plug-in space heaters, no hot water except for rooms where have attached a propane tank and hose to hook it into the existing sinks. By Western standards, I'm horrified. But they're still better off than many other places in the world.

One of the surveys I was looking at had a blank for the bit of data about whether forceps or a vacuum were used to assist with delivery. According to our staff member, there's only one OB in the entire hospital trained to use forceps.

They had a number of hand-made signs that were meant to educate women about proper breastfeeding practices and the various family planning methods. I have some great drawings that someone did of some of the methods that I'll post when I get back. They did have an error in the exclusive breastfeeding guidance (they said 4-6 months, where it should be 6 months), which I pointed out to our expert doing an assessment of the facility. I guess I did learn something in those 9 years at CCP! Ha ha.

Tomorrow is Saturday but we're still going to be working. I guess I'll hope for a nice hike in the mountains some other time.....

Gotta go! Everyone's done at the cafe so I can't hold the gang up.

My 4th of July

While many of my readers may be enjoying hot dogs on the barbecue, potato salad, fireworks and beer today, I spent another half day looking through maternal records. In the afternoon the quality consultant from Moldova did a presentation on Safe Motherhood and the standards of care for managing the three stages of childbirth. Because so much of practice here was based on their own biological/physiological research but not epidemiological data, there's a huge emphasis on evidence-based medicine. It really helps when trying to explain to providers why their practices and/or technologies are outdated.

I'm happy to report that there was no gruel this morning but fried eggs, rice, and "tvorog," which is a Russian cheese that is more sour and less creamy than ricotta cheese. Alas, the "hot water" was really only less than freezing cold after running for a full 20 minutes. Tomorrow will be a better day: we aren't leaving for the next site, Karakol, until noon so I'll be able to actually enjoy the lake and lie on the beach for a bit. And I believe there will be hot water at the next stop! Yeeee-ha!

I took some great photos today of the lake, mountains, the Sanitorium, a squirrel (which is golden brown, not grey as they are in the States), and a lovely monument of Lenin. I was surprised to see it still up--most of the former Soviet states disposed of their Lenin statues in short order after the fall of the empire. It's not one of those huge, imposing ones, but made me feel nostalgic for Moscow nonetheless. Alas, I won't be posting any pics until I get back to Almaty. Apologies for that.

Cholponata, Kyrgyzstan

Where there's only hot water 3 hours a day at the Sanitorium Blue Issyk-Kul, and the electricity runs only sometimes. :) This morning I felt like Oliver Twist when I went down to breakfast and got a scant 1/4 cup of thin gruel. (Though I didn't want to say "more, please.")

Today I spent all day poring over patient records and provider data entry forms, spot-checking and validating various indicators. Never in my life did I expect to be reading patient charts in Russian, in Kyrgyzstan! It was amazing. Tomorrow I'm going to validate the client forms.

I'm at an internet cafe but hope to take some pictures and get a swim in their famous lake before going back to the maternity tomorrow. There's this phenomenal ob/gyn/professor from Moldova that was also doing a site visit, which ended up with him re-teaching many of the new young obs how to plot partograms properly. He was filling out data on the quality and availability of the services here, but it ended up with him teaching for about the last 4 hours.

Of Cell Phones, Shashleek, and Upcoming Work

So Saturday I endeavored to acquire a cell phone. Since I’ll be on the road a lot, I want to make it easy for people to reach me. And make phone calls to the States without dealing with finding hotels or wifi for Skyping (which I’m not holding my breath for in places like Tadjikistan).

We stopped at a few stores that are a lot like a Sprint or T-Mobile stores back home. Then they took me to “Tsum.” I will post a photo of it soon (sorry, spaced on bringing the digital with me to the wifi cafe). There were probably 10,000 cell phones on display, and hundreds of people shopping for them. The cell is a big status symbol here. I was picking out very ordinary, bottom-of-the line, practical ones, and my friends were vetoing them left and right.

Cell phones are also expensive here. Nor do you get a monthly plan with a pre-determined calling level and rate. You have to go to a special store that gives out SIM cards and cell phone numbers, and register your phone there. Then you buy a card with some amount of tenge (the local currency), which you load onto your phone and gets translated into minutes. You can fill your phone either in person at the main store, through one of their "Bankomats" (not a tough one to figure out--ATM machine), or continue to buy the cards at any kiosk or store. Much simpler process in the states.

The good ones that people covet run about $600 to $800. Average salary here is $750. You do the math. Then you buy cards and load your minutes onto the phone, at about $0.25 per minute.
So now I’ve got me a styling hot pink phone that takes pictures and also can listen to the radio and a bunch of other features I’ll likely never use. It kicks my phone’s ass back home. Looks like I upgraded my phone in Kazakhstan! That I never expected.

Tonight we went out with a bunch of Anara’s work friends. Shashleek, similar to shish-kebab is big here. See the forthcoming pics of the presentation. Some were lamb, others beef, still others pork and even fish. Mine were stuffed with eggplant, tomato, and other veggies. Yum yum.

I also watched 6 people (4 of whom were women) consume 2 bottles of cognac. It was Kazakstani ccognac, and quite good, actually. But I had forgotten just how much people drink here. Everyone gets a healthy shot of the beverage, you toast, and everyone shoots the entire shot. Lather, rinse, repeat. I guess they thought I was a fuddy-duddy drinking wine, but I don’t need a hangover just yet. I had Georgian wine, which was quite tasty.

If my Kyrgyzstan visa comes through Monday morning, Monday afternoon I’m on a plane to Bishek, then to Karakol via driver. After about a week there working with their MCH/RH coordinator, I’ll be off to Tadjikistan to see a MCH training take place over three weeks. The typical training trains a “healthy birth and infant” team that are comprised of obs, midwives, neonatal nurse specialists, and one more provider that I've forgotten. They get trained in essential maternal and newborn care for uncomplicated births via WHO-accredited trainers, and are taught to practice evidence-based delivery care with minimal medical intervention. We gather baseline data of the provider birth practices, then data at least every 6 months on provider practices after the training. To help validate the provider-centered data, we also ask new mothers to fill out a questionnaire about their experience in the maternal hospital. We’re coming up the completion of the third data collection, which I’ll be spot-checking and analyzing to see whether our training and other health care interventions (I’ll talk about them later) have an effect on the indicators we’re interested in (process-related, such as evidence-based practices, as well as outcome related, such as reduction in stillbirths).

I can’t wait to hit the road! Almaty is great, but I want to see as much as I can of Central Asia while I’m here.

29 June 2007: Day 1

Day 1: What a whirlwind!

I had just arrived, caught up with my friends, when the doorbell rang. It was the driver, I needed to go get visa photos because Monday they want me to head to Kyrgyzstan. Talk about getting me out in the field! Their RH coordinator is going on holiday for a month, and since I’ll be taking over her work while she’s away they wanted me to overlap with her for a week or so before she left.

Then it was hearing more about the project and the work I’ll be doing. Then I got to meet everyone in the office, then another meeting about the RH/MCH work being done in Kazakhstan. I still hadn’t showered from the flight, much less unpacked. It’s just a taste of what’s to come, but that’s good: I’m here to work and learn as much as I can.